Breath Holding Episodes

01 What Do I Need To Know?

  • Breath holding episodes (BHE) occur in one in 20 children between the ages of six months to eight years. The majority of children grow out of them by the age of six years. They usually begin in the first year of life and peak at two years.
  • They are also called Breath Holding Attacks or Spells.
  • Typically they occur after a minor episode or when the child has a fright. The child then cries and holds their breath. A reflex action then occurs.
    • Blue or Cyanotic episodes are the most common. The child will begin to cry, lose their breath, turn red in the face and then blue. It lasts for a short period and the child may become floppy and fall to the ground.
    • Pale or Pallid episodes are less common. The child opens their mouth as if to cry and then goes floppy and faints. In some episodes the child may become stiff or arch their backs. They recover quickly and may be drowsy and sleepy for a while.
  • In most children the diagnosis is easily made after a careful review of their medical history, a physical examination and further tests are usually not needed. 


  • Significant pallor and loss of consciousness without any provoking factors such as a tantrum or fall.
  • Very frequent breath holding attacks e.g. several per week, or more than once a day. This could still  be considered ’within normal limits’, but it may be best to have further investigations regardless.
  • Additional symptoms such as: prolonged stiffening or shaking and /or associated with a slow recovery; needing to sleep for several hours afterwards; or remaining confused for longer than several minutes after an attack.


  • The best way to manage BHE is to anticipate when the attacks are most likely to occur.
  • Tantrums may be minimised by distracting the child and avoiding situations that trigger the episodes. If a temper tantrum is the usual cause, try and work out what is happening at the time: is it boredom, tiredness or various activities? However, if it is a tantrum that seems to trigger the episodes, it’s important not to treat your child differently or in any special way when a tantrum occurs. Try not to rush to them when they start to cry.
  • Medication is almost never used and would only be considered in very rare cases when other measures have failed.


  • A few children with BHE have significant anaemia and low amounts of iron in their blood, which limits the oxygen carrying capacity of the blood. A recent review suggests that it is worth treating children with iron supplements especially those who are iron deficient, and/or children with more severe and frequent episodes. The dosage used is 6mg/kg/day for a minimum of 3 months. See review in I want to know more section

02 What Others Say

Excellent fact sheets are available from these sites 

  • Sydney Children’s Hospital

  • Royal Children’s Hospital  Melbourne

  • Raising children’s network

  • UK website

03 I Want To Know More

04 Clinicians Tools and Resources

  • Excellent overview of infant syncope

The information published here has been reviewed by Flourish Paediatrics and represents the available published literature at the time of review.
The information is not intended to take the place of medical advice.
Please seek advice from a qualified healthcare professional.
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Last updated: 26/06/2011 by Dr ElizabethHallam*